Name:_________________________________________________    Age:_________          

Address:_______________________________________________

        _______________________________________________                        

Phone:_________________________________________________                         


Is the above named scholarship applicant a year-round resident of the Town of Bourne?                        


I declare that the information provided above is true and complete.


Signed:____________________________________________     Date:_________________               


Scholarship applications should be accompanied by a completed Buzzards Sailing School 
registration form.